The Effects of Task Related Training on Mobility and Ambulation in People with Chronic Stroke

The effects of CVA often result in decreased independence and quality of life. Many people with chronic stroke are limited in their ability to pursue meaningful activities because their impairments prevent them from returning to community ambulation. A well-established body of evidence demonstrates that, with rehabilitation, people with chronic stroke can improve performance of functional tasks. Rehabilitation in these studies involved task and context specific training of skills involved in lower extremity function. Studies of Constraint-Induced Movement Therapy (CI Therapy) which employs intense massed practice to increase the tendency of patients to use their more impaired limb have yielded positive results. Neuroimaging studies have shown that CI Therapy produce\u27s a cortical reorganization associated with improved use of the affected limb. The intensity and duration of rehabilitation necessary to achieve functional gains has not yet been determined. Task related training, one form of rehabilitation for people with chronic stroke, has also shown promising results. The purpose of this study was to investigate the efficacy of a task related training class \u27in improving mobility and ambulation skills in people with chronic stroke. It was also intended to assess if a community-based group program would have an affect on the health status of people with chronic stroke. Four subjects were recruited from the greater Portland area. Following doctor approval for participation in the study, subjects were evaluated three or more weeks prior to initiation of the intervention, at the beginning of the intervention, immediately following completion of the intervention and two or more months after the intervention. Assessment tools included the Timed Up and Go (TUG), Ten Meter Walk Test, Six Minute Walk Test, and the Health Status Questionnaire (HSQ-12). The treatment protocol was a task related training program designed to increase lower extremity function for mobility and ambulation. The subjects participated in three one and one half hour sessions weekly for three weeks. The first hypothesis was that there would be significant gains in mobility and ambulation following completion of the exercise program as measured by the assessment tools noted above. The second hypothesis was that a community based group rehabilitation program would have a positive effect on health status, defined as the physical and social function or emotional well being of people with chronic stroke as measured by the Health Status Questionnaire (HSQ-12). A significant increase in speed was gained from the pre-test to the final on the 10 Meter Walk and the Timed Up and Go tests. This was maintained at the 2 month follow up only for the 10 Meter Walk Test. While the results of the Six Minute Walk Test and the Step Test were not statistically significant, they demonstrated a trend toward improvement in mobility and ambulation skills. Over the training period, walking speed and endurance, balance and stability appeared to improve. There was no significant change or apparent trend in HSQ-12 results